ABSTRACT
Esthetic rehabilitation of cleft lip and palate patients presents a myriad of challenges and requires interdisciplinary coordination. In the present case report, a 22-year-old male patient with a cleft palate and alveolus was treated. Comprehensive multidisciplinary treatment planning and management, along with a clinician-friendly process of smile designing and of creating mock-ups using digital technology, helped overcome the esthetic challenges faced in this case.
ABSTRACT
Background: Preeclampsia is pregnancy specific disease, lead to maternal, perinatal morbidity and mortality. This study is conducted to identify the socio demographic profile of subjects suffering from preeclampsia and its effect on maternal and fetal health.Methods: This prospective study was conducted at department of obstetrics and gynecology, Kamla Nehru State Hospital, Shimla, in this, 100 preeclamptic women were included. Preeclampsia was diagnosed with blood pressure of ≥140/90 mmHg noted for the first-time during pregnancy, after 20 wks of gestation and proteinuria. Demographic details were collected. Investigations i.e. hemogram, liver and renal function tests, coagulation profile and fundoscopy were done. Maternal and perinatal outcomes were recorded.Results: In this study, majority of the subjects were primigravida 65. In this, 11 subjects had systolic blood pressure of 140-159 mmHg and 89 subjects had systolic blood pressure of > 160 mmHg. 25 subjects had diastolic blood pressure of 90-109 mmHg and 75 subjects had diastolic blood pressure of > 110 mmHg. In this, 82 subjects had warning symptoms, mainly headache 49. 14 subjects showed hypertensive changes in fundus. Unfavorable Bishop Score, observed in 86 subjects and 78 subjects were induced after controlling blood pressure. Majority of subjects had vaginal delivery 73. Majority of the subjects had deranged liver function 61. Maternal morbidity was reported in 54 subjects. Intrauterine death reported in 14 subjects. Birth weight was < 2.5 kg was observed in 70 babies. Out of 74 live births, 53 neonates required admission in NICU and 16 neonates died in NICU.Conclusions: It may be concluded that, maternal and neonatal morbidity and mortality can be reduced by early identification of risk factors and timely intervention is the hall mark in preventing the maternal and perinatal morbidity and mortality.
ABSTRACT
Background: This study assessed level of non-adherence to anti tuberculosis (TB) therapy among pulmonary TB patients, compares various factors among adherent and non-adherent TB patients, stressing on reasons for non-adherence at a tertiary care hospital.Methods: This institution based observational and cross-sectional study was conducted interviewing patients with pulmonary TB and assessed using Moriskys medication adherence scale-8 (MMAS-8), a pre- tested structured questionnaire based scoring system of patients treated for pulmonary TB at district TB centre SIMS, Shimoga. Descriptive statistics were employed.Results: Among 70 cases analysed, 57 were males and 13 females, with mean age group of 41.32�63 and mean MMAS score of 2.23�87. 53.33% patients were on continuous phase of treatment. The level of non-adherence were as follows, high= 18%, medium= 38% and low= 44%. The common cause for non-adherence was forgetfulness (66%) reasons being: betterment of symptoms (54%), sickness after taking medication (31%), distance of travel: far (15%). Many were labourers (62%), with low literacy rate, also chronic alcoholics (72%) and smokers (73%). Female with moderate literacy and not addicted to alcohol/smoking showed high adherence compared to males (p<0.05%).Conclusions: As prevalence of non-adherence is high, especially Patients on continuous phase of TB treatment, there arises immense need for continuous and effective health education to patients� and their family regarding the adverse effects and the need for high level of adherence to treatment for the complete cure of disease. Patients who are addicted to alcohol/smoking should be targeted with interventions to quit the same, provide free transport facility to RNTCP centres and prompt treatment of ADR, will improve adherence to medication.
ABSTRACT
Background: Healthcare workers gain adequate knowledge related to medications used in treating illness from their work experiences which influences self medication practices.Methods: The present study was conducted in N=150 healthcare workers, divided into 2 groups with group I (nursing staff) and group II (paramedical staff) with 75 participants in each group. Data related to self medication was obtained from a pretested validated semi structured questionnaire either in Kannada or English. The responses were compared between each group with chi square test. P value ?0.05 was considered significant. All statistical analysis was conducted with SPSS 16.Results: The mean age (mean±SD) of the participants in group I and group II is 31.79±8.309 and 34.15 (±8.168) respectively with p =0.081. The prevalence of self medication was 100% in both the groups. Both the groups knowledge related to the definition of self medication was similar (group I 63 (84.0%) and group II 62 (82.7%) p = 0.900). Group I believes that self medication is entirely safe compared to group II which was statistically significant (group I 66 (88.7%) and group II 46 (61.3%) p=0.029). Most common drugs used for self medication was NSAIDS (non steroidal anti-inflammatory drugs) in both the groups being 75 (100%). Antibiotics was used by 26 (2.66%) in group I and 14 (18.66%) in group II.Conclusions: Self medication practice is highly prevalent in the healthcare workers, who also influence the other populations to practice self medication. Practicing responsible self medication is more appreciable.
ABSTRACT
Background: A number of foot ulcer classification systems have been devised in an attempt to categorize ulcers more effectively and allow effective comparison of the outcome of routine management. DUSS (Diabetic Ulcer Severity Score) is one of the latest wound based system of classification, which needs to be validated. Aims and Objectives: Our aim was validation of this diabetic ulcer severity score (DUSS), with patients outcome including healing and amputation. Methods: Total of 100 Diabetic patients attending surgical outpatient clinic or admitted into the hospital (BMCRI) with diabetic foot ulcers from September 2014 to September 2016 were included in the study. Necessary data was collected .DUSS score was calculated for each patient and analysis was done using SPSS package version16. Results: Most common age group affected with Diabetic foot was between 41 -60 years. Males were commonly affected by Diabetic foot ulcers accounting to 68% .Most commonly ulcers were of DUSS Score of 2 followed by Score 3. Overall 50 (50.0%) of 100 people had amputations in our study. Major Amputation was done for 25% of patients. Minor Amputation was done in 25% of patients in our study. The probability of healing with score 0 was 95%,91.6% with score 1,85.7% with score 2,52% with score 3, and 28.5% with score 4. Conclusion: DUSS scoring system provides an easy diagnostic tool for predicting probability of healing or amputation .This is a very simple and easy scoring system which needs no advanced investigation tool and can be easily followed even in busy OPDs.
ABSTRACT
Background: Acquired immunodeficiency syndrome (AIDS) is caused by human immunodeficiency virus (HIV), which is an RNA virus. The first case of AIDS in human beings was reported in 1981, and now spread of HIV infection is alarmingly high with around 20 million deaths. The objective of the study was to determine the cost distribution of antiretroviral therapy among autoimmune deficiency syndrome (AIDS) patient attending the anti-retroviral therapy (ART) center of the tertiary care center. Methods: The objective of the study was to determine the cost distribution of antiretroviral therapy among AIDS patient attending the ART center of the tertiary care center. The study was retrospective, 20 patients included in different age groups and categories the cost incurred toward patients were divided under different heads: medication, laboratory diagnosis, transport, and miscellaneous costs. Results: It was found that major part of the cost is spent on drugs. The cost of transport and lab diagnosis varied based on age and stage of the disease. Miscellaneous costs were also high and were proportional to other costs. Conclusion: HIV infected population is more likely to have a lower socioeconomic status which has varied effect on the effectiveness of highly active ART. Some of the problems faced by them are access to health care, transport, economic instability, etc. all these factors have an impact on outcome of treatment. Overall it can be found that preventive measure than treating has better impact on quality of life.
ABSTRACT
Background: Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia. DM is a leading cause of blindness, end stage renal disease, and nontraumatic lower extremity amputations. The objective of the study was to evaluate the drug utilization pattern of antidiabetic medications at a tertiary care hospital. Methods: Demographic details of the patient were noted. Evaluation of the written prescription was carried out according to the requirements in case record form followed by computerization of data and analysis. Results: DM was almost equal in male (51%) and females (49%), the risk of DM was high after 40 years of age. Out of all the case records and prescriptions reviewed it was found that 23% had Type 1 DM, and 77% had Type 2 DM. In 46.35% cases, there was a family history of DM while in 47.44% cases it was absent, 6% were unaware. The average number of drugs per prescription was 3.26±0.24 and antidiabetic drugs at 1.72±0.28. Insulin alone was prescribed in 25.54% cases. Single antidiabetic agents as lone drugs were seen in 39.05%; combined oral antidiabetic drugs accounted for 25.54% cases. The combination of insulin and oral antidiabetic agents were prescribed in 9.85% cases. Conclusion: Metformin was the oral hypoglycemic agents, which was the most frequent prescribed as was insulin and its analogs. These drugs being essential in the treatment of diabetic patients should be made available to patients all the time.
ABSTRACT
Background: Patients are admitted in the intensive care unit (ICU) with a history of various acute and chronic clinical conditions associated with organ failures. Compared to the patients admitted in the general wards the mortality and morbidity are high in ICU patients. The patients in ICU are subjected to multiple drugs; diuretic agents are liberally and deliberately used in this setup despite the lack of evidence supporting their benefits. Methods: The main aim of the study was to know the extent of use of diuretics in the ICU set up, to categorize the use of diuretics in different clinical conditions and different classes of diuretics used. The study also tried to determine adverse events and outcome in critically ill patients. The study was a retrospective cross-sectional of 3 months duration conducted in all patients admitted in the medical ICU of the tertiary care center. The study mainly concentrated on the usage of diuretics and related aspects. Results: Loop diuretics (54.81%) composed the major class, thiazides (30.84%). Potassium sparing diuretics (7%) and osmotic diuretics (7%) and carbonic anhydrase inhibitors (1%) were the other class of diuretics. The classes of drugs used in ICU along with diuretics were antibiotics (30%), analgesics (9.5%), anti-inflammatory (6.36%), and drugs acting on blood (10.18%) of total drugs used in ICU. Antacids/ laxatives (7.3%) and antiemetic (4.8%), the rest of drugs (15%) of drugs used in ICU. Conclusion: In almost 95% of cases, the combination of other drugs along with diuretics was considered to be rational.
ABSTRACT
Background: No pharmacotherapeutic agent is completely free from noxious and unintended effects and thus adverse drug reactions (ADRs) are inevitable consequences of drug therapy. Incidence of ADRs in Indian population ranges between 1.8% and 25.1%. However, ADR reporting in India is inadequate. Developing awareness inpatients and healthcare professionals (HCPs) will help in reducing the ADRs, its suffering and socioeconomic impact. Hence, the present study of ADR monitoring in the outpatients and inpatients of the medicine department in a tertiary care hospital is undertaken. The main objective of this study was to assess the ADR reporting patterns in outpatient and inpatient of medicine department. The study was also aimed to assess the causality, severity, and preventability of these ADRs and comparison between spontaneous reporting by HCP and patient selfreporting of suspected ADRs. Methods: This study was a prospective observational study conducted in 111 consecutive patients who experienced ADRs in the department of medicine. The study plan included analysis and assessment of the clinical pattern, spectrum of ADRs reported based on causality, severity, preventability factors. The impact of ADRs on emotional, occupational, and social life of patients was evaluated. The assessments were compared between patient reporting and HCP reporting of ADRs. Results: The clinical spectrum of ADRs ranged from the more common mild reactions such as skin rashes, itching, nausea, and vomiting to moderately severe reactions prolonging the hospital stay. The predominant causative drugs were antimicrobials, antiretrovirals, non-steroidal anti-inflammatory drugs and antihypertensives. The majority of ADRs were probable in causality assessment, moderate in severity and probably preventable. Comparison of ADR reporting between patient and HCP revealed that ADRs reported by patient’s been less in incidence, similar in qualitative analysis to HCP with very elaborative narration and highlighted emotional and occupational impact due to ADRs than HCP reports. Conclusion: A wide range of ADRs are possible in medicine department. Adequate awareness of ADR reporting and precautions, while prescribing drugs are essential. Including patients as additional reporters of suspected ADR may add to the benefit of pharmacovigilance.
ABSTRACT
Background: The present study was planned to explore the genotoxic potential of some commonly used antimicrobials like ornidazole and secnidazole in swiss albino mice. Methods: Therapeutic equivalent doses of ornidazole and secnidazole were given by intra peritoneal route. Single dose in individual groups of mice (n=5 in each) was administered for acute study. Doses were repeated every 24 hrs for 7 times in additional groups of mice (n=5 in each) for sub-acute study. Cyclophosphamide served as positive control while normal saline as negative control. After 24 hrs of single dose (acute study) and last dose of drug administration in sub-acute study, about 0.5 ml of blood was collected by retro orbital sinus for comet assay as described earlier (Rojas E et al, 1999) and later the mice were sacrificed to aspirate the femoral bone marrow for micronucleus test as described earlier by described by Schmid W (1975). In comet assay, the total comet length and head diameter was measured under microscope using ocular & stage micrometer to calculate comet tail length. In micronucleus assay, the stained bone marrow tissue smears were scored for the frequency of micronucleated polychromatic erythrocytes (MnPCE) and also the ratio between polychromatic erythrocytes (PCE) to normochromic erythrocytes (NCE) was obtained. Results: It was analyzed by one-way ANOVA followed by Dunnet’s multiple comparison tests. Significant (P< 0.01) increase in comet tail length and percentage of micronucleated polychromatic erythrocytes (% MnPCE) was observed in groups treated with single and multiple doses of Cyclophosphamide whereas ornidazole and secnidazole treated groups did not show any significant changes. Conclusions: The results indicate that Ornidazole and secnidazole are devoid of genotoxicity.
ABSTRACT
Background: Gastroesophageal reflux disease (GERD) is a common clinical condition in Indian population. Antacids, which are available as over the counter (OTC) are the commonly prescribed drugs for treatment of GERD. Antacids manufactured and marketed by various multinational and local companies are available in the market. There is need for evaluating the cost effectiveness and efficacy of these antacids as a matter of public concern. Hence the present study was conducted to evaluate the cost effectiveness and efficacy of the commonly prescribed antacid gel preparations. Methods: Seven different gel formulations of antacids manufactured by different companies were evaluated. Cost effectiveness was done by calculating the cost per ml of antacid and also by palatability test. Efficacy was evaluated based on acid neutralizing capacity (ANC) of antacid preparations. Results: The highest cost was 0.305 Rs. per ml and lowest was 0.135 Rs per ml. Palatability score was high at 26.80 and low at 23.85. The antacid with lowest ANC was 20.5 mEq and the highest was 26.5 mEq. Conclusion: Cost effectiveness studies are beneficial in improving the prescribing pattern. It will be a benefit for both doctor as well as patient.
ABSTRACT
Objectives: This study was undertaken to evaluate the effect of intramuscular valethamate bromide on the duration of labor, rate of cervical dilatation and the effect of the drug on the mother and the fetus. Material and Methods: This was a prospective study conducted in Dept. of Obstetrics and Gynecology at ESIC MC-PGIMSR Bangalore involving 200 women with fullterm pregnancy in active labor. Group A received valethamate bromide intramuscular injection. Group B was control group. Results: There was no significant difference in the parity, mean age of patients and mean duration of gestation in both the groups. But, there was difference in the mode of delivery. Valethamate bromide caused significant decrease in the duration of cervical phase of labor as compared to control group. There was no statistically significant difference in the Apgar score of new borns, and there were no maternal and fetal side effects. Conclusion: Valethamate bromide can be used in the management of labor for reducing the duration of first stage of labor without any untoward effects on mother and fetus.